To be effective, chaplains must listen to patients, administrators In his work as a chaplaincy consultant, the Rev. George Handzo has seen the situation over and over again: The chaplains on one side of the hospital working hard but feeling unappreciated and administrators on the other side of the hospital, asking, "What do the chaplains do all day? We never see them."
The dynamic is a symptom of the larger problem of unaligned expectations, and chaplains would be wise to address such concerns upfront, Rev. Handzo advised during last month's CHA-sponsored webinar, "Pastoral Care Staffing: Making the Case for Quality." Rev. Handzo is vice president of pastoral care leadership and practice with HealthCare Chaplaincy of New York, a consulting and training company.
He said that hospital administrators and pastoral care departments always have expectations of one another. "There is always a contract between chaplaincy services and the facility — whether it is explicit or implicit. Often, it is unspoken or not understood by the chaplain. Often, it is disregarded by the chaplain.
"Expectations need to be aligned," he said. "Or this is a recipe for budget cuts in the pastoral care department."
Pastoral care professionals need to think strategically in order to ensure they are of value to the hospital, Rev. Handzo said. They must understand the hospital's goals and how they can contribute to achieving them. They also need to understand patients' needs and ensure they are meeting them.
Inevitably this strategic approach will require that the pastoral care department measure its work, Rev. Handzo said. Chaplains should figure out what numbers they will need to collect in order to determine where the needs are in the hospital and how the department will respond.
"These are not 'numbers for numbers' sake,'" Rev. Handzo said. Instead, he said, they are numbers that measure the effectiveness of the department in contributing to the hospital's work.
A chaplaincy department likely will want to track the number of referrals made, the number of chaplain visits conducted, the services rendered and the percentage of patients visited in certain high-priority departments.
Rev. Handzo said the metrics can help pastoral care departments to figure out how to cover their responsibilities throughout the hospital. He described several measurement models, noting that there are pros and cons to using each:
- Ratios: This model looks at the typical ratio of chaplains to patients in hospitals and then benchmarks to that number. It is a helpful approach for getting a general idea of how large a pastoral care department should be, but it does not account for the idiosyncrasies of specific facilities.
- Grant/Riverside Acuity Staffing Process: GRASP uses staffing ratios and also accounts for the acuity level of patients. The model accounts for variations in staff levels between facilities with different acuity levels, but it is not necessarily an intuitive tool to use for identifying next steps in improving chaplaincy work.
- Units of service: This model from a chaplain at the Mayo Clinic in Rochester, Minn., measures chaplain work as units of service instead of visits. This way of measuring aligns with how other hospital departments measure their work. While the approach is useful for determining what services are delivered, it is less useful for identifying how those services deviate from expectations.
Rev. Handzo said pastoral care departments can use the measurement options that work best for them.
He said that ongoing quality improvement work is a natural extension of measuring performance — the data and strategic planning will allow a chaplaincy department to identify areas in need of attention.
This type of strategic thinking will help to ensure that the pastoral care department is known as a valuable contributor to the mission and not a "throw-away" department, Rev. Handzo said.
"We have to justify our work," he said. "The customer is the hospital, and the hospital will only pay for what it values. It only values what advances its agenda.
"You have to pay attention and make sure you're moving that agenda forward," he said.